MEDICARE: WAY TO THRIVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1043143365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAY TO THRIVE

Provider Business Mailing Address
First Line	:	2146 DIVISION AVE S
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3031
Country	:	US
Telephone Number	:	616-287-5375
Fax Number	:

Provider Business Practice Location Address
First Line	:	2146 DIVISION AVE S
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3031
Country	:	US
Telephone Number	:	616-287-5375
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MALLORY WAAYENBERG
Credential	:	MA,LLPC
Telephone Number	:	616-570-7132

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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Directions to “WAY TO THRIVE ” Practice Location

Language	Start Address	Practice Location

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